Profil de sensibilisation aux allergènes des asthmatiques adultes à Kinshasa, RDC : Etude transversale par prick-tests

Contexte. Environ 80% des asthmatiques sont atopiques. La sensibilisation aux allergènes communs présente certaines variabilités environnementales et géographiques. Objectif. Déterminer le profil de sensibilisation aux allergènes communs des asthmatiques adultes de la ville de Kinshasa. Méthodes. De juin 2017 à février 2018, 216 asthmatiques de 18 ans et plus, des 2 sexes, ont été consécutivement recrutés aux Cliniques Universitaires de Kinshasa et dans certaines paroisses et églises de réveil de la ville de Kinshasa. A l'aide d'un questionnaire validé, les variables sociodémographiques ont été précisées. Le prick-test a été réalisé avec cinq extraits commerciaux standardisés de phanères de chien et chat, l'acarien de poussière de maison (Blomia tropicalis, Bt), les moisissures (Alternaria alternata), et le jaune d'œuf. Résultats. L'âge moyen de la population était de 45,23 (ET=17,56) ans, 74% de sexe féminin, 47 % non sensibilisés et 53% sensibilisés à au moins un allergène. Vingt-cinq pourcent étaient monosensibilisées et 27% plurisensibilisées. Le profil de sensibilisation était Blomia tropicalis (72%), phanères de chat (46%), phanères de chien (34%), Alternaria alternata (13%) et jaune d'œuf (11%). Conclusion. Une plurisensibilisation aux allergènes communs chez les asthmatiques dans notre milieu est présente dont le profil dominé par les acariens et les phanères de chats. Des enquêtes futures incluant un plus grand nombre de sujets et recourant à des batteries de tests plus élargies s'imposent en vue d'une définition d'options diagnostiques et thérapeutiques dans notre contexte

Allergen-Specific Immunotherapy in Patients 55 Years and Older: Results and Review of Literature

Over the years the immune system suffers many morphologic and functional alterations, which result in a peak of function in puberty and a gradual decrease in the elderly. Aim: Treat patients 55 years or older with allergic rhinitis with immunotherapy and then analyze the response to allergens. Materials and Methods: From June 2009 to July 2010, 104 charts of patients 55 years or older with allergic complaints were evaluated. The patients were selected by anamnesis, physical examination, and otorhinolaryngologic exam. The patients had cutaneous test for mites before and after 1 year of sublingual specific immunotherapy. The cutaneous response was classified as negative (absent), light, moderate, or severe. Results  Before vaccination, 42 (40.4%) patients were classified as having a severe form of allergy and 62 (59.6%) as having a moderate allergy. After the specific therapy, 40 (38.4%) patients were classified as negative (absent), 37 (35.6%) as light, 19 (18.3%) as moderate, and 8 (7.7%) as severe responses. Conclusion: Immunotherapy, a desensitization technique, is indicated in cases which patients cannot avoid the exposure to allergens and in situations where pharmacologic therapy is not ideal. Specific immunotherapy to treat the allergic rhinitis in elderly patients was efficient and had no collateral effects, and in addition to the clinical benefit, improvement in the cutaneous test could also be observed...

Frecuencia de sensibilización alimentos y aero-alergenos en pacientes recibidos en el laboratorio de Corpodiagnostica C.A. durante el periodo 2010-2011 / Frequency of sensitization for food and aero-allergens in patients reciived in a Venezuelan laboratory during 2010-2011 period

La alergia tipo I se ha definido como una reacción inmunológica adversa mediada por IgE que se produce después de una exposición repetida al alérgeno. La prevalencia de las alergias ha aumentado considerablemente en los últimos 20 años, lo que aumenta la necesidad del estudio de la respuesta a varios alérgenos. El objetivo fue evaluar la frecuencia de sensibilización a alimentos y aero-alérgenos en los pacientes referidos al Laboratorio de Corpodiagnostica C.A. durante el periodo 2010-2011. Se determinó niveles de IgE específica a 2445 pacientes, usando el método inmunoblot in vitro RIDA Allergy-screen (r-Biopharm, Alemania). La tasa de sensibilización total medida por IgE específica a alimentos fue de 30,43%, donde los alimentos más comunes fueron Leche, Queso, Trigo, Maíz y Cerdo; mientras que la tasa de sensibilización para aero-alérgenos fue de 46,16%; de los cuales los más comunes fueron los ácaros mayores y B. tropicalis. Este estudio provee de una herramienta importante para la identificación de los alérgenos alimentarios y respiratorios de mayor prevalencia en la población venezolana.

Type I allergy had been defined as an adverse immunologic reaction mediated by IgE that occurs after a repeated exposure to the allergen. The prevalence of the allergies has increased considerably in the last 20 years, thus increasing the need of study the response to several allergens. The objective was to evaluate the frecuency of foods and respiratory allerges sensitization in patients referred to Corpodiagnostica Laboratory (Caracas, Venezuela, ISO 9001:2008 certified laboratory) in the period that correspond from January 2010 to July 2011. We determinated specific IgE levels to 2445 patients, by the in vitro RIDA® Allergy-screen immunoblot method (r-biopharm®, Germany). The total sensitization rate mediated by specific IgE to food allergen was 30,43% where the foods most common were milk, cheese, wheat flour, corn and pork; while the sensitization for aero-allerges was 46,16%; the most common were the major mites and B. tropicalis. This study provides an important tool for the identification of food and aero-allergens with major prevalence in the Venezuelan population.

Safety of Accelerated Schedules of Subcutaneous Allergen Immunotherapy with House Dust Mite Extract in Patients with Atopic Dermatitis

The safety of accelerated schedules of allergen immunotherapy (ASAI) in patients with bronchial asthma (BA) has been reported but there are little data on the safety of ASAI for patients with atopic dermatitis (AD). In this study, we investigated the safety of ASAI in patients with AD. Sixty patients with AD and 18 patients with BA sensitized to house dust mites (HDM) were studied. A maximum maintenance dose of HDM extract, adsorbed to aluminum hydroxide, was administered to patients by subcutaneous injection with either a 3-day protocol (rush immunotherapy) or 1-day protocol (ultra-rush immunotherapy). Systemic reactions were observed 4 of 15 patients (26.7%) with AD during rush immunotherapy, 13 of 45 patients (28.9%) with AD during ultra-rush immunotherapy, and 4 of 18 patients (22.2%) with BA during rush immunotherapy (P > 0.05). No severe or near fatal systemic reactions occurred in 78 subjects of this study. Systemic reactions developed within 4 hr after administration of the maximum allergen dose in 20 of 21 patients (95.2%) with AD and BA who showed systemic reactions during rush or ultra-rush immunotherapy. In conclusion, ASAI was safe and well tolerated in patients with AD. ASAI can be a useful therapeutic option for AD.

Factors associated with non-adherence to specific allergen immunotherapy in management of respiratory allergy.

Background. Non-adherence to specific allergen immunotherapy is a major hurdle faced by the allergist, contributing to poor clinical outcomes. Objectives. To assess the independent association of various factors with non-adherence to specific allergen immunotherapy. Methods. Fifty consecutive (non-adherent) and control (adherent) subjects receiving specific allergen immunotherapy were included in the study and various factors related to non-adherence including socio-demographic, clinical and immunotherapy related variables were compared between the two groups by univariate and multivariate analysis. Results. On univariate analysis, gender, allergic conjunctivitis, family history, progression of disease, perception of immunotherapy, medicine requirement, and the pattern of missed doses greater than two in the last 10, 20 and 30 doses were found to be significantly associated with non-adherence. On multivariate analysis, independent association was observed with allergic conjunctivitis, family history, perception of immunotherapy, missed doses greater than two in the last 10 doses of immunotherapy and medicine requirement. Conclusions. The independent factors associated with non-adherence may vary between different settings and countries. There is a need for developing individual case holding programmes to improve clinical outcomes in patients receiving specific allergen immunotherapy.

Conduta diagnóstica e terapêutica na sinusite da criança / Diagnosis and teherapeutic management in children's sinusitis

Objetivo: Revisar os principais aspectos relativos a diagnóstico e conduta frente à suspeita de sinusite em crianças, segundo a literatura pertinente. Método: Levantamento bibliográfico. Resultado: São estabelecidos critérios de suspeita clínica da patologia, de indicação de exames microbiológicos e radiológicos, assim como da abordagem medicamentosa e cirúrgica para as diferentes situações clínicas em que a sinusite é diagnosticada. Conclusões: A padronização de condutas clínicas frente à sinusite da crinça permite uma otimização de exames comprovatórios assim como na utilização de antimicrobianos e outros fármacos e na cirurgia em casos selecionados

The effect of allergen immunotherapy on in vitro IL-4 and IFN-gamma production by peripheral mononuclear cells in house dust-sensitive Chinese patients with bronchial asthma.

The IFN-gamma produced by Th1 cells and IL-4 produced by Th2 cells are two most important cytokines in the regulation of IgE production. House dust immunotherapy has been tried in the treatment of house dust-sensitive Chinese asthmatic patients with good results. We examined the influence of such treatment on in vitro IL-4 and IFN-gamma production by peripheral blood mononuclear cells in house dust-sensitive asthmatic patients. Allergen immunotherapy in house-dust sensitive asthmatic patients can significantly decrease IL-4 production from peripheral mononuclear cells (p<0.05). The production levels of IL-4 in patients without treatment had higher levels than those in patients with hyposensitization (p<0.01). Such therapy also have some effect on promotion of IFN-gamma production in asthmatic patients. In conclusion, immunotherapy with house dust may have the potential ability to shift the Th1/Th2 balance of immune response to allergens and to create a favorable cytokine microenvironment to suppress the allergic reaction in the asthmatic airway.

Controle ambiental nas doenças alérgicas: prós e contras / Environmental control in allergic diseases what is yes and what is not

Objetivos: Controle ambiental é parte integrante e importante da estratégia global de qualquer tratamento alérgico e está continuamente recebendo novas informaçoes científicas. Discute-se aqui a importância deste controle, as alérgenos principais do ambiente domiciliar e quais sao as medidas de controle que sao eficientes e as que nao sao. Métodos: Testes cutâneos, contagem direta de ácaros, testes de guanina e métodos de controle dos alérgenos ambientais sao também os aspectos clínicos e a quantidade de alérgenos detectados no ambiente e provocadores de sensibilizaçao do paciente alérgico. Resultados: Alguns métodos utilizados funcionam e outros nao para diminuir a quantidade de alérgenos ambientais. Conclusao: O controle ambiental deve fazer parte da estratégia global do tratamento do alérgico.

Localized periorbital edema as a clinical manifestation of sulfite sensitivity

Sulfite is commonly used in pharmaceuticals as a preservative. We report a unique clinical presentation of localized periorbital edema on the left eye after administration of sulfite-containing dexamethasone. The patient's sulfite sensitivity was confirmed by sulfite oral provocation test: periorbital edema on the same site developed after ingestion of 200 mg sodium bisulfite. She was non-atopic and did not complain of any respiratory symptoms. Allergy skin prick test with 100 mg/ml sodium bisulfite showed a negative result. She also has aspirin-sensitive urticaria which was confirmed by oral provocation test. In conclusion, sulfite can induce a localized periorbital edema, an uncommon manifestation in sensitive patients. Further investigations are needed to clarify the pathogenetic mechanisms.

Imunoterapia específica com extrato de pó domiciliar em pacientes com asma brônquica / Specific immunotherapy with home powder extraction in patients with bronchial asthma

A eficácia da imunoterapia específica em pacientes asmáticos, com hiperssensibilidade ao pó domiciliar, foi estudada em 98 pacientes, dos quais 54 foram submetidos a um ano, 35 a dois anos e 15 a três anos de imunoterapia. Baseado somente em parâmetros clínicos, conclui-se, pela análise estatísticas dos dados coletados, que a imunoterapia específica com extrato de pó domiciliar, em pacientes asmáticos com hiperssensibilidade a este alérgono, é provavelmente um método eficaz para reduzir a sensibilidade brônquica. Deste modo, este estudo nos mostra que a imunoterapia específica é um método racional que deve ser usado no tratamento de doenças alérgicas